Cardiology Flashcards
How is symptomatic bradycardia managed if atropine fails?
External pacing is used for symptomatic bradycardia if atropine fails
Why shouldn’t verapamil be prescribed along with a beta blocker for angina?
While verapamil is a calcium channel blocker it should not be prescribed alongside a beta-blocker due to the risk of complete heart block.
When should ivabradine (a long-acting nitrate) be considered in a patient with angina?
Long-acting nitrates should not generally be used as monotherapy and should only be considered as an add-on if the patient cannot tolerate the combination of a beta-blocker and calcium channel blocker.
When is fibrinolytic therapy considered for an acute presentation of a STEMI?
Fibrinolytic therapy should only be used if there is a significant delay in being able to provide PCI.
PCI should be chosen if it can be delivered within 120 minutes of the time when fibrinolysis could have been given (i.e. consider fibrinolysis if there is a significant delay in being able to provide PCI).
What is the chief anatomical indication for a CABG?
The chief anatomical indications for CABG are the presence of triple-vessel disease or severe left main stem artery stenosis.
How long do NICE recommend we wait following a myocardial infarction before prescribing a phosphodiesterase type 5 inhibitor?
The correct answer is 6 months. According to the National Institute for Health and Care Excellence (NICE) guidelines, it is recommended to wait at least 6 months after a myocardial infarction before prescribing a phosphodiesterase type 5 inhibitor such as sildenafil. This is because there is an increased risk of cardiovascular events in patients who have recently experienced a myocardial infarction, and phosphodiesterase type 5 inhibitors can potentially exacerbate this risk by causing systemic vasodilation and reducing blood pressure.
What is a normal corrected QT interval? What is prolonged?
less than 430 ms in males and 450 ms in females.
Prolonged would me > 450ms men and >460ms in women
Following ACS, what are the five drugs patients should be discharged with?
dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin
What is the criteria to treat stage 1 hypertension?
treat if < 80 years of age AND any of the following apply; target organ damage, established cardiovascular disease, renal disease, diabetes or a 10-year cardiovascular risk equivalent to 10% or greater
When is bioprosthetic heart valve offered as opposed to mechanical?
According to UK guidelines, this intervention is recommended for patients aged >65 years or younger patients not wishing to take lifelong anticoagulation. Bioprosthetic valves have the advantage of not requiring long-term anticoagulation, unlike mechanical valves, and are generally preferred in older patients due to their better hemodynamic properties and lower risk of thromboembolic complications.
Younger patients given a biopresthetic valve would also be more at risk of biodegradation.
In what situation would you prioritise giving shocks before CPR in a cardiac arrest?
Although patients in VF/pulseless VT should receive one shock followed by two minutes of CPR, if they are witnessed having the cardiac arrest and are monitored (e.g. coronary care unit, critical care unit, catheter laboratory) then they should receive a maximum of three successive shocks instead. Chest compressions would then follow and CPR would be continued for 2 minutes.
First-line treatment for regular broad complex tachycardias without adverse features?
What would be considered as adverse features?
IV amiodarone
shock, syncope, myocardial ischaemia or heart failure
What drug is contraindicated in ventricular tachycardia?
Verapamil is contraindicated in VT as intravenous administration of a calcium channel blocker can precipitate cardiac arrest.
How do you treat acute AF which is haemodynamically unstable?
Acute presentation of atrial fibrillation: if signs of haemodynamic instability (e.g. hypotension, heart failure) → electrical cardioversion, as per the peri-arrest tachycardia guidelines
When should synchronised vs unsynchronised DC cardioversion be used?
Unsynchronised DC cardioversion should be used in patients with pulseless VT/VF or unstable polymorphic VT, where synchronised cardioversion is impossible. A patient with tachyarrhythmia with discernible R waves should have synchronised DC conversion.
What are the indications of synchronised DC cardioversion?
Tachycardia with haemodynamic instability, signs of myocardial ischaemia, heart failure or syncope are indications for synchronised DC cardioversion.
What is the criteria to have ivabradine as part of 3rd line treatment option in HF?
criteria: sinus rhythm > 75/min and a left ventricular fraction < 35%
What is the indication for cardiac resynchronisation therapy in HF?
a widened QRS (e.g. left bundle branch block) complex on ECG
What vaccinations are offered to HF patients?
offer annual influenza vaccine
offer one-off pneumococcal vaccine
- adults usually require just one dose but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years
What are the parameters for the different stages of hypertension?
Stage 1 hypertension Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg
Stage 2 hypertension Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg
Severe hypertension Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg
What three heart structural disorders cause a pan systolic murmur?
This type of murmur is heard with tricuspid and mitral regurgitation and a ventricular septal defect.
What causes an early vs late diastolic murmur?
Early: aortic regurgitation
Late: mitral stenosis, tricuspid stenosis, myxoma, and complete heart block.
For a patient with symptomatic stable angina on a calcium channel blocker but with a contraindication to a beta-blocker, the next line treatment should be?
long-acting nitrate, ivabradine, nicorandil or ranolazine
What is interval of LFT testing for statins and when should statins be stopped
LFTs at baseline, 3 months and 12 months. Treatment should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range
